Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OSCE > Other > Flashcards

Other Flashcards

1
Q

What are the 5 main steps to confirming a death?

A
  1. Confirm patient identity, 2. Check for response to stimuli, 3. Check pupillary responses, 4. Feel the carotid pulse, 5. Auscultate for heart and lung sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If after a fluid status examination a patient is found to be hypovolaemic, what should you do?

A

Initiate fluid resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some clinical signs of a patient being fluid overloaded?

A

Raised JVP, peripheral/sacral/pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should be done next if an individual’s blood glucose has been > 14mmol/L for more than 2 hours?

A

Check blood ketones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Excessive amounts of IV 0.9% sodium chloride can result in what metabolic abnormality?

A

Hyperchloraemic metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can you calculate what one unit of insulin will reduce an individual’s blood glucose by?

A

100 / total daily dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In any patient with a reduced urine output (< 0.5ml/kg/hour), a fluid challenge should be given. What is meant by this?

A

250-500ml of 0.9% sodium chloride or Hartmann’s solution over 15 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some further investigations you may consider doing after a fluid status examination?

A

Bloods (Hb, U&Es, renal function), imaging (CXR, ECHO, abdominal US)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The main advantage of 5% dextrose is being able to maintain hydration without administering an excess of electrolytes. However, if required it can be prescribed with supplementary amounts of what electrolyte?

A

Potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the main components of the general examination section of a fluid status examination?

A

End of the bed assessment (SOB, oedema, medical equipment), hands (CRT, skin turgor), pulse and BP, neck (JVP), eyes and mouth (dry mucous membranes), legs (oedema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are maintenance fluids calculated for children?

A

100ml/kg for first 10kg, 50ml/kg for the next 10kg, 20ml/kg for any additional kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medication should you be aware of that increases fluid losses?

A

Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If after a fluid status examination a patient is found to be euvolaemic, what should you do?

A

Calculate maintenance fluids (if required)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should you check for a response to stimuli when confirming death?

A
  1. Assess for a verbal response, introduce yourself and ask the patient if they can hear you, 2. Assess for a response to pain by applying supraorbital pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 2 main reasons that somebody may become hypervolaemic?

A

Increased fluid intake, fluid retention (e.g. cardiac/renal failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is the fluid within the extracellular space divided into compartments?

A

1/4 is found in the intravascular space (plasma) while 3/4 are found in the extravascular space (interstitial fluid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the correction dose of insulin for people who remain hyperglycaemic (BM 10-15mmol/L) despite their normal subcutaneous insulin? (assuming they haven’t just eaten and have taken a bolus)

A

10% of total daily dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the daily requirement of water?

A

25-30ml/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should you do if a patient appears euvolaemic but has signs of shock?

A

Seek expert help immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What electrolytes are found in 1L of 0.9% sodium chloride?

A

154mmol of sodium and chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What electrolytes are found in 1L of Hartmann’s solution?

A

131mmol sodium, 111mmol chloride, 5mmol potassium, 2mmol calcium and 29mmol bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If after a fluid status examination a patient is found to be hypervolaemic, what should you do?

A

Do not prescribe IV fluids and seek senior help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are you hoping to achieve when giving a fluid challenge?

A

Increase in BP and decrease in HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What electrolyte can be added to 0.9% sodium chloride if required?

A

Potassium (as 20 or 40mmol KCl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the daily requirement of sodium, potassium and chloride?

A

1-2mmol/kg/day for sodium, 1mmol/kg/day for potassium and chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is most people’s baseline rate of insulin, e.g. a sensible dose to start someone on who is first diagnosed with type 1 diabetes?

A

0.5 units/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How many units of insulin are in 1ml?

A

100 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the correction dose of insulin for people who remain hyperglycaemic (BM > 15mmol/L) despite their normal subcutaneous insulin? (assuming they haven’t just eaten and have taken a bolus)

A

20% of total daily dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Fluid losses from non-urine sources are termed insensible losses- these will increase in who?

A

Acutely unwell patients

30
Q

What are the most important questions to ask yourself before prescribing any fluids?

A

What type of fluid prescribing is required? What is the weight and size of the patient? Are there any co-morbidities to consider? What are their most recent electrolytes?

31
Q

The concentrations of which ion(s) is/are normally high in the intracellular fluid and low in the extracellular fluid?

A

Potassium

32
Q

What type of resuscitation fluids should be used in children?

A

0.9% sodium chloride

33
Q

Approximately what proportion of prescribed 0.9% sodium chloride remains within the intravascular space?

A

25%

34
Q

Describe the main components of the chest examination section of a fluid status examination?

A

Respiratory rate, central CRT, auscultate heart and breath sounds, palpate for sacral oedema

35
Q

If you are going to confirm a death and the patient’s family or friends are present, what should you do?

A

Explain who you are and offer your condolences. Explain what you are there to do and offer them the opportunity to stay or leave

36
Q

You should call for help from intensive care when a patient hasn’t responded to what volume of fluid challenge?

A

2000ml

37
Q

What are the 3 main reasons that somebody may become hypovolaemic?

A

Inadequate fluid intake, increased fluid losses, third space fluid loss

38
Q

What is the target urine output for patients?

A

> 0.5ml/kg/hour

39
Q

How are resuscitation fluids calculated for children?

A

Bolus of 20mg/kg over < 10 minutes

40
Q

Describe the main components of the abdominal examination section of a fluid status examination?

A

Inspect for distension and wounds/drains, assess for shifting dullness

41
Q

Potassium should not be given at a rate greater than what?

A

10mmol per hour

42
Q

Which crystalloid fluid has no role in resuscitation scenarios?

A

5% dextrose

43
Q

NG feeding/enteral feeding is preferred when maintenance IV fluid have been given for how long?

A

3 days

44
Q

Unless an urgent ABCDE approach is required, what should you look at before doing a fluid status examination?

A

NEWS chart, fluid charts, medication chart, stool chart

45
Q

What electrolytes are found in 1L of 5% dextrose?

A

None- just 50g of glucose

46
Q

What questions should you ask at the beginning of a fluid status assessment?

A

Have they been eating/drinking? Do they have any signs/symptoms of dehydration e.g. thirst, dizziness? Do they have any signs/symptoms of fluid overload e.g. SOB, PND, orthopnoea, oedema? Do they have any ongoing losses e.g. vomiting/diarrhoea, wounds/drains, bleeding? Do they have cardiac or renal failure?

47
Q

How should you document a confirmation of death?

A

Document each of the steps you have gone through and what the response was, state the date and time at which death was confirmed, sign and print your full name along with your grade, GMC number and contact number

48
Q

What is the main indication for the use of human albumin solution?

A

Decompensating liver disease

49
Q

What should you do after confirmation of a death if not done already?

A

Discuss the death with the consultant to clarify the cause to write on the death certificate

50
Q

How long should you auscultate for heart and lung sounds when confirming a death?

A

Listen for heart sounds for at least 2 minutes and breath sounds for at least 3 minutes

51
Q

What are some clinical signs of a patient being fluid deplete?

A

Dry mucous membranes and reduced skin turgor, decreasing urine output, orthostatic hypotension

52
Q

What type of maintenance fluids should be used in children?

A

0.9% sodium chloride and 5% glucose

53
Q

Other than electrolytes, what additional metabolic product is contained within Hartmann’s solution?

A

Lactate

54
Q

Hartmann’s solution should not be used in individuals with what electrolyte abnormality?

A

Hyperkalaemia

55
Q

How is total daily insulin divided in a basal bolus regimen?

A

50% basal, 50% bolus (divided into three meals)

56
Q

What three things should you use to guide your fluid management?

A

Clinical assessment, fluid charts and U&Es

57
Q

What is the daily requirement of glucose?

A

50-100g/day

58
Q

The concentrations of which ion(s) is/are normally high in the extracellular fluid and low in the intracellular fluid?

A

Sodium, calcium and chloride

59
Q

How should the pupils look after death?

A

Fixed and dilated

60
Q

What proportion of total body weight is water? Of this weight, what proportion is intracellular and extracellular?

A

2/3rds of total body weight is water: 2/3rds of this water is intracellular, 1/3rd is extracellular

61
Q

What are some drugs that can cause hyperkalaemia?

A

Potassium sparing diuretics

ACE inhibitors/ARBs

Heparin

Ciclosporin

62
Q

What are some drugs that can cause hypokalaemia?

A

Thiazide and loop diuretics

63
Q

What are some drugs that can cause hyponatraemia?

A

Thiazide and loop diuretics

SSRIs

64
Q

What are some drugs that can cause hypercalcaemia?

A

Thiazide diuretics

65
Q

How do you calculate a breakthrough dose of morphine?

A

1/6th of total daily dose

66
Q

How is the dose of oral codeine/tramadol converted to oral morphine?

A

Divide dose by 10

67
Q

How is the dose of oral morphine converted to subcutaneous or intravenous morphine?

A

Divide dose by 2

68
Q

What must you always prescribe alongside an opioid?

A

A laxative

69
Q

What type of opiate medication is best to use in patients with mild-moderate renal impairment?

A

Oxycodone

70
Q

What types of opiate medication are best to use in patients with severe renal failure?

A

Alfentanil/fentanyl

Buprenorphine

OSCE (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions